肺泡灌洗液高通量测序病原检测在儿童血液肿瘤中的应用价值  

Value of Pathogenic Detection by Next-Generation Sequencing in Bronchoalveolar Lavage Fluid on Children with Hematological Malignancies

作　　者：吴彬 汪洁 张兰男 唐威 陈开澜[1] WU Bin;WANG Jie;ZHANG Lan-Nan;TANG Wei;CHEN Kai-Lan(Department of Oncology,Wuhan Children’s Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430016,Hubei Province,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院肿瘤科,湖北武汉430016

出　　处：《中国实验血液学杂志》2025年第2期569-574,共6页Journal of Experimental Hematology

基　　金：湖北省自然科学基金-青年项目(2019CFB368)。

摘　　要：目的:探讨支气管肺泡灌洗液(BALF)宏基因组高通量测序(mNGS)病原学检测在儿童血液肿瘤肺炎患者中的临床应用价值。方法:回顾性分析本院因肺炎行BALF mNGS病原检测的血液肿瘤患儿的临床资料。所有患儿均接受了肺泡灌洗液mNGS检测以及传统方法检测(包括痰培养、肺泡灌洗液培养、血培养、病原血清学检测等)。通过对mNGS及传统方法检测结果的分析,比较不同检测方法的阳性率、病原学分布等指标。结果:26例血液肿瘤患儿纳入研究,其中男12例,女14例,中位年龄4.9(1.8-14.9)岁,共进行35例次支气管肺泡灌洗术(BAL)。BALF mNGS共检出病原微生物17种,最常检出的细菌、病毒和真菌分别为肺炎链球菌、巨细胞病毒和耶氏肺孢子菌。BALF mNGS检出细菌9例次、病毒10例次、真菌3例次、支原体2例次、混合感染8例次,其检测的阳性率为91.43%,显著高于传统方法检测(20%,P<0.001)。共有25例次根据BALF mNGS结果进行抗感染方案调整。结论:BALF mNGS技术的应用能够提高血液肿瘤患儿肺部感染病原的检出率,初步揭示了该群体肺部感染病原谱,能够有效指导临床用药,提高治疗效果。Objective:To investigate the application value of bronchoalveolar lavage fluid(BALF)metagenomic next-generation sequencing(mNGS)in etiological diagnosis of children with hematological malignancies complicated with pneumonia.Methods:We retrospectively analyzed the clinical data of children with hematological malignancies who underwent BALF mNGS pathogenic detection due to pneumonia.All patients underwent mNGS detection of bronchoalveolar lavage fluid as well as traditional methods(including sputum culture,bronchoalveolar lavage fluid culture,blood culture,serological detection of pathogens,etc.).By analyzing the results of mNGS and traditional methods,we compared key indicators such as the positive rate,etiological distribution.Results:A total of 26 children with hematological malignancies enrolled in the study,including 12 males and 14 females,with a median age of 4.9(1.8-14.9)years,underwent bronchoalveolar lavage(BAL)35 times.A total of 17 pathogenic microorganisms were detected in BALF mNGS,including 9 cases of bacterial infection,10 cases of viral infection,3 cases of fungal infection,2 cases of mycoplasma infection and 8 cases of mixed infection,and the most commonly detected bacteria,viruses and fungi were streptococcus pneumoniae,cytomegalovirus and pneumocystis jirovecii,respectively.The positive rate of mNGS detection(91.43%)was significantly higher than that of traditional methods detection(20%,P<0.001).A total of 25 cases were adjusted according to BALF mNGS results.Conclusion:The application of BALF mNGS technology can improve the detection rate of the pathogens in children with hematological malignancies complicated with pneumonia,initially revealed the pathogen spectrum of pulmonary infection in this group,and effectively guide clinical medication,improve treatment outcomes.

关 键 词：儿童 血液肿瘤 肺泡灌洗液 宏基因组高通量测序 

分 类 号：R725.6[医药卫生—儿科]